背景:在加拿大,新生儿发病率远远超过死亡率。新生儿不良结局指标(NAOI)总结新生儿发病率,但加拿大缺乏趋势数据。
方法:这项加拿大范围的回顾性横断面研究包括妊娠24至42周的住院分娩,从2013年到2022年。数据来自加拿大健康信息研究所的出院摘要数据库,不包括魁北克。NAOI包括15种新生儿并发症(例如,出生创伤,脑室内出血,或呼吸衰竭)和七种干预措施(例如,通过插管和/或胸部按压进行复苏),改编自澳大利亚的NAOI。NAOI率按胎龄计算。计算新生儿死亡率的未调整比率(RR)和95%置信区间(CI)。新生儿重症监护病房(NICU)入院,延长住院时间,每个与存在的NAOI组分的数量相关(0、1、2、3、4或≥5)。
结果:在2,821,671名新生儿中,NAOI率为7.6%。NAOI从2013年的7.3%增加到2022年的8.0%(p<0.01)。大多数早产儿的NAOI患病率最高。与没有NAOI相比,死亡率的RR(95%CI)为8.5(7.6-9.5),其中1,118.1(108.4-128.4),3和395.3(367.2-425.0),其中≥5个NAOI成分。NICU入院的RRS分别为6.7(6.6-6.7),11.2(10.9-11.3),和11.9(11.6-12.2),延长住院时间的RR为6.6(6.4-6.7),12.2(11.7-12.7),和26.4(25.2-27.5)。国际比较表明,加拿大的NAOI患病率较高。
结论:加拿大NAOI使用住院数据捕获新生儿发病率,并与新生儿死亡率相关,NICU入院,和延长住院时间。近年来,新生儿发病率可能呈上升趋势。
BACKGROUND: In Canada, newborn morbidity far surpasses mortality. The neonatal adverse outcome indicator (NAOI) summarizes neonatal morbidity, but Canadian trend data are lacking.
METHODS: This Canada-wide retrospective cross-sectional study included hospital livebirths between 24 and 42 weeks\' gestation, from 2013 to 2022. Data were obtained from the Canadian Institute of Health Information\'s Discharge Abstract Database, excluding Quebec. The NAOI included 15 newborn complications (e.g., birth trauma, intraventricular hemorrhage, or respiratory failure) and seven interventions (e.g., resuscitation by intubation and/or chest compressions), adapted from Australia\'s NAOI. Rates of NAOI were calculated by gestational age. Unadjusted rate ratios (RR) and 95% confidence interval (CI) were calculated for neonatal mortality, neonatal intensive care unit (NICU) admission, and extended hospital stay, each in relation to the number of NAOI components present (0, 1, 2, 3, 4, or ≥5).
RESULTS: Among 2,821,671 newborns, the NAOI rate was 7.6%. NAOI increased from 7.3% in 2013 to 8.0% in 2022 (p < 0.01). NAOI prevalence was highest in the most preterm infants. Compared to no NAOI, RRs (95% CI) for mortality were 8.5 (7.6-9.5) with 1, 118.1 (108.4-128.4) with 3, and 395.3 (367.2-425.0) with ≥5 NAOI components. Respective RRs for NICU admission were 6.7 (6.6-6.7), 11.2 (10.9-11.3), and 11.9 (11.6-12.2), and RR for extended hospital stay were 6.6 (6.4-6.7), 12.2 (11.7-12.7), and 26.4 (25.2-27.5). International comparison suggested that Canada had a higher prevalence of NAOI.
CONCLUSIONS: The Canadian NAOI captures neonatal morbidity using hospitalization data and is associated with neonatal mortality, NICU admission, and extended hospital stay. Newborn morbidity may be on the rise in recent years.